4590 Federal Register / Vol. 71, No. 18 / Friday, January 27, 2006 / Notices 

recommend allowing additional time to 

clear security. 

In order to gain access to the building 

and grounds, individuals must present 

photographic identification to the 

Federal Protective Service or Guard 

Service personnel before being allowed 

entrance. 

Security measures also include 

inspection of vehicles, inside and out, at 

the entrance to the grounds. In addition, 

all individuals entering the building 

must pass through a metal detector. All 

items brought to CMS, whether personal 

or for the purpose of demonstration or 

to support a demonstration, are subject 

to inspection. We cannot assume 

responsibility for coordinating the 

receipt, transfer, transport, storage, setup, safety, or timely arrival of any 

personal belongings or items used for 

demonstration or to support a 

demonstration. 

Parking permits and instructions will 

be issued upon arrival. 

Note: Individuals who are not registered in 

advance will not be permitted to enter the 

building and will be unable to attend the 

meeting. 

The public may not enter the building 

earlier than 30 to 45 minutes prior to the 

convening of the meeting. 

All visitors must be escorted in areas 

other than the lower and first floor 

levels in the Central Building. 

Authority: 5 U.S.C. App. 2, section 10(a). 

(Catalog of Federal Domestic Assistance 

Program No. 93.774, Medicare—

Supplementary Medical Insurance Program) 

Dated: December 12, 2005. 

Barry M. Straube, 

Acting Chief Medical Officer and Acting 

Director, Office of Clinical Standards and 

Quality, Centers for Medicare and Medicaid 

Services. 

[FR Doc. E6–704 Filed 1–26–06; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare and Medicaid 

Services 

[CMS–1328–N] 

Medicare Program; February 15, 2006 

Town Hall Meeting on the Practice 

Expense Methodology Including the 

Proposal From the Physician Fee 

Schedule Proposed Rule for Calendar 

Year 2006 

AGENCY: Centers for Medicare and 

Medicaid Services (CMS), HHS. 

ACTION: Notice of meeting. 

SUMMARY: This notice announces a 

Town Hall meeting on our methodology 

for establishing practice expense (PE) 

values for services paid under the 

physician fee schedule (PFS). The 

purpose of this meeting is to: (1) Clarify 

our proposed revisions to the PE 

methodology contained in the PFS 

calendar year (CY) 2006 proposed rule; 

and (2) receive comments and opinions 

from individuals of the medical 

community regarding ideas for the CY 

2007 PFS proposed rule. This meeting is 

open to the public, but attendance is 

limited to space available. 

DATES: The Town Hall meeting is 

scheduled for Tuesday, February 15, 

2006 from 1:30 p.m. to 4:30 p.m. e.s.t. 

ADDRESSES: The Town Hall meeting will 

be held at the Centers for Medicare and 

Medicaid Services, 7500 Security 

Boulevard, Baltimore, MD 21244–1850 

in the auditorium in the central 

building. 

Meeting Registration: Persons wishing 

to attend this meeting must register by 

contacting Debbie Cooley at Centers for 

Medicare & Medicaid Services, 7500 

Security Boulevard, Mail stop C4–03–

06, Baltimore, MD 21244–1850, or, by 

FAX at 410–786–4490 to the attention of 

Debbie Cooley. Please include the name 

of the attendee and the organization he 

or she represents, if applicable. This 

information must be received by 5 p.m., 

e.s.t, on Friday, February 10, 2006. 

This meeting will be held in a Federal 

Government building, the Centers for 

Medicare and Medicaid Services; 

therefore, persons attending this 

meeting will be required to show a 

government-issued photo identification 

and a copy of their confirmation of 

registration for the meeting. Access may 

be denied to persons without proper 

identification. In planning your arrival 

time, we recommend allowing 

additional time to clear security. 

Security measures include: Inspection 

of vehicles, inside and out, at the 

entrance to the grounds; passing 

through a metal detector; and, the 

inspection of all items brought into the 

building. Laptops and other computer 

equipment must be registered with the 

security desk upon entry. Please note 

that CMS headquarters is a smoke-free 

complex. 

FOR FURTHER INFORMATION CONTACT: 

Debbie Cooley, (410)786–0007 or 

Dorothy Shannon, (410)786–3396. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Since January 1, 1992, Medicare has 

paid for services of physicians and other 

practitioners under a physician fee 

schedule. This schedule sets payment 

rates for 7,000 services based on the 

resources used to provide those services 

and is updated annually. To construct 

the fee schedule, we assign values 

called relative value units (RVUs) to 

each service. The total RVUs for a 

service are the sum of the work RVUs 

(which include the physician’s time and 

effort); the practice expense RVUs 

(which cover expenses such as 

overhead, staff, and supplies); and the 

malpractice expense RVUs (which cover 

malpractice premiums). 

In the CY 2006 PFS proposed rule (70 

FR 45764), we outlined our plans to 

revise the practice expense (PE) 

methodology. There were three major 

parts to our proposal: 

1. Changing from a ‘‘top-down’’

methodology for calculating direct PE to 

a ‘‘bottom-up’’ approach. Currently, on 

a specialty-specific basis, we derive a PE 

per physician hour from aggregate 

survey data, create a cost pool using 

Medicare utilization data, and then 

allocate the pool to all the services 

performed by the specialty. This 

methodology is complex, often not 

intuitive, and produces some PE values 

that can change significantly from yearto-year. The proposed bottom-up 

approach would use the sum of the 

typical resource costs for clinical staff, 

supplies, and equipment required for 

each service. These typical costs for 

each service would be determined based 

primarily on recommendations we 

reviewed and accepted from the 

American Medical Association’s 

Relative Value Update Committee 

(RUC). We would then convert these 

costs into direct cost PE RVUs. We 

believe this methodology is easier to 

understand and more intuitive than the 

current top-down approach, and should 

also improve the stability of the PE 

RVUs over time. In addition, because 

most of the inputs that would be used 

in the bottom-up calculation have been 

approved by the multi-specialty RUC, 

the medical community has already 

agreed to their accuracy. 

2. Accepting the supplementary PE 

surveys from seven specialties—allergy, 

dermatology, urology, gastrointestinal, 

cardiology, radiology, and radiation 

oncology—and using these in the 

calculation of indirect PE. 

3. Calculating, on a code-specific 

basis, the higher of the current portion 

of the PE RVU for indirect costs (the 

indirect PE RVU) or the indirect PE RVU 

resulting from acceptance of the 

supplementary surveys. 

This proposal was to have the effect 

of mitigating the redistributive effects of 

accepting the seven supplementary 

surveys by ensuring that, before 

application of PE budget neutrality, the 

indirect PE RVUs for each service were 


rmajette on PROD1PC67 with NOTICES
Federal Register / Vol. 71, No. 18 / Friday, January 27, 2006 / Notices 4591 

no lower than the current indirect PE 

RVUs. 

In comments on the CY 2006 PFS 

proposed rule, commenters indicated 

that they did not understand the 

mechanics of our proposals and that 

there was not enough information for 

specialties to analyze them. Many 

commenters requested a 1-year delay in 

implementation of our proposals to 

allow time for CMS to provide further 

information and to give other specialties 

an additional opportunity to submit 

their own supplementary survey. 

After reviewing the CY 2006 PFS 

proposed rule comments, we 

determined that the proposal for 

revising the indirect PE was confusing 

to the public because the published PE 

values and impacts were incorrect. 

Therefore, in the CY 2006 PFS final rule 

(70 FR 70116), we withdrew the 

proposed PE revision for 2006 and used 

the 2005 PE RVUs for most services. The 

only exceptions were to price the codes 

that were new in 2006 and, as required 

by the Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003 (MMA) (Pub. L 108–173), to use 

the new urology PE data in the 

calculation of the drug administration 

codes used by their specialty. 

As we indicated when we issued the 

CY 2006 PFS final rule (70 FR 70116), 

we intend to work with the medical 

community to ensure that any future 

proposals to change the PE methodology 

are understandable and informed by 

input from the medical community. As 

the initial step in this process, we are 

holding this Town Hall meeting to 

provide this opportunity. 

II. Meeting Format 

This meeting will begin with an 

overview of the objectives of the 

meeting along with an introduction of 

the topics to be discussed during the 

meeting which include: 

• Clarifying our efforts to revise the 

PE methodology in the CY 2006 PFS 

proposed rule which include: 

+ The change from a ‘‘top-down’’

methodology for calculating direct PE to 

a ‘‘bottom-up’’ approach utilizing the 

direct cost inputs; 

+ The use of the accepted 

supplementary PE surveys from the 

seven specialties in the calculation of 

indirect PE; 

+ The intended method of obtaining 

the indirect PE values; and 

+ The elimination of the 

nonphysician workpool and the related 

impacts. 

• A question and answer session that 

offers the meeting attendees an 

opportunity to clarify further the topics 

discussed. 

• Soliciting input from individual 

attendees on each facet of our 

methodology: direct PE, indirect PE, 

supplementary surveys, and 

nonphysician workpool. The comments 

provided during this meeting will assist 

us in the preparation of the physician 

fee schedule proposed rule for CY 2007. 

To provide a basis of understanding 

before the meeting we will be posting 

information concerning the PE 

methodology on our Web site at http:// 

www.cms.hhs.gov/PhysicianFeeSched/. 

This information will include current 

PE values, examples for deriving PE 

values using the bottom-up 

methodology, and projected impacts of 

these revisions. We encourage 

individuals to familiarize themselves 

with this material before the meeting. 

Copies of this information will be 

available on the day of the meeting. 

Authority 

(Catalog of Federal Domestic Assistance 

Program No. 93.774, Medicare—

Supplementary Medical Insurance Program). 

Dated: January 19, 2006. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 06–747 Filed 1–26–06; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare and Medicaid 

Services 

[CMS–1318–N] 

Medicare Program; Meeting of the 

Practicing Physicians Advisory 

Council, March 6, 2006 

AGENCY: Centers for Medicare and 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces a 

quarterly meeting of the Practicing 

Physicians Advisory Council (the 

Council). The Council will meet to 

discuss certain proposed changes in 

regulations and carrier manual 

instructions related to physicians’

services, as identified by the Secretary 

of Health and Human Services (the 

Secretary). This meeting is open to the 

public. 

DATES: The Council meeting is 

scheduled for Monday, March 6, 2006, 

from 8 a.m. until 5 p.m. e.s.t. 

ADDRESS: The meeting will be held in 

Room 705A 7th floor, in the Hubert H. 

Humphrey Building, 200 Independence 

Avenue, SW., Washington, DC 20201. 

MEETING REGISTRATION: Persons wishing 

to attend this meeting must register by 

contacting Kelly Buchanan, the 

Designated Federal Official (DFO) by email at PPAC@cms.hhs.gov or by 

telephone at (410) 786–6132, at least 72 

hours in advance of the meeting. This 

meeting will be held in a Federal 

Government Building, Hubert H. 

Humphrey Building, and persons 

attending the meeting will be required 

to show a photographic identification, 

preferably a valid driver’s license, and 

will be listed on an approved security 

list before persons are permitted 

entrance. Persons not registered in 

advance will not be permitted into the 

Hubert H. Humphrey Building and will 

not be permitted to attend the Council 

meeting. 

FOR FURTHER INFORMATION CONTACT: 

Kelly Buchanan, (410) 786–6132, or email PPAC@cms.hhs.gov. News media 

representatives must contact the CMS 

Press Office, (202) 690–6145. Please 

refer to the CMS Advisory Committees’

Information Line (1–877–449–5659 toll 

free), (410) 786–9379 local) or the 

Internet at http://www.cms.hhs.gov/ 

faca/ppac/default.asp for additional 

information and updates on committee 

activities. 

SUPPLEMENTARY INFORMATION: In 

accordance with section 10(a) of the 

Federal Advisory Committee Act, this 

notice announces the quarterly meeting 

of the Practicing Physicians Advisory 

Council (the Council). The Secretary is 

mandated by section 1868(a)(1) of the 

Social Security Act (the Act) to appoint 

a Practicing Physicians Advisory 

Council based on nominations 

submitted by medical organizations 

representing physicians. The Council 

meets quarterly to discuss certain 

proposed changes in regulations and 

carrier manual instructions related to 

physicians’ services, as identified by the 

Secretary. To the extent feasible and 

consistent with statutory deadlines, the 

Council’s consultation must occur 

before Federal Register publication of 

the proposed changes. The Council 

submits an annual report on its 

recommendations to the Secretary and 

the Administrator of the Centers for 

Medicare and Medicaid Services (CMS) 

not later than December 31 of each year. 

The Council consists of 15 physicians, 

including the Chair. Members of the 

Council include both participating and 

nonparticipating physicians, and 

physicians practicing in rural and 

underserved urban areas. At least 11 

members of the Council must be 

physicians as described in section 

1861(r)(1) of the Act; that is, Statelicensed doctors of medicine or 


rmajette on PROD1PC67 with NOTICES